From the Guidelines
The RSR pattern in V2 is a diagnostic indicator of right bundle branch block (RBBB) when the QRS complex is widened (≥120 ms) and is accompanied by specific morphological criteria, including an rsr', rsR, or rSR pattern in leads V1 or V2, as defined in the 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay 1.
Key Characteristics of RBBB
- QRS duration ≥120 ms
- rsr', rsR, or rSR pattern in leads V1 or V2
- S wave of greater duration than R wave or >40 ms in leads I and V6 in adults
- Normal R peak time in leads V5 and V6 but >50 ms in lead V1
Clinical Significance
The RSR pattern in V2, indicative of RBBB, can be found in healthy individuals but may also suggest underlying heart disease, such as coronary artery disease, cardiomyopathy, or congenital heart defects. Therefore, clinical correlation is crucial when this pattern is identified. The presence of RBBB may influence the management and prognosis of patients, particularly in the context of other cardiac conditions.
Diagnostic Considerations
In evaluating the RSR pattern in V2, it is essential to consider the entire ECG and clinical context, as other conditions may mimic or coexist with RBBB. The 2018 ACC/AHA/HRS guideline provides a comprehensive framework for the evaluation and management of patients with bradycardia and cardiac conduction delay, including those with RBBB 1.
From the Research
Rsr Pattern in V2
- The rsR' pattern in leads V1-V2 is a frequently encountered entity in clinical cardiology, with causes ranging from benign and nonpathological to severe and life-threatening diseases, such as Brugada syndrome or arrhythmogenic right ventricular dysplasia 2, 3.
- An rsR' pattern in leads V1-V2 can be observed when ECG leads are placed in the 2nd intercostal space, and new ECG criteria based on the r' wave can accurately identify rsR' patterns in V1-V2 from potential Brugada type 2 patterns in patients with purposely placed high precordial leads 4.
- The differential diagnosis of an rsR' pattern in leads V1-V2 involves a history and physical examination to screen for underlying cardiac disease and potential triggers, routine investigation involves blood work and a thorough electrocardiographic examination, and echocardiography has a role in evaluating patients in whom structural heart disease is suspected 3.
- Stress echocardiography is a well-established technique for the diagnosis and risk stratification of patients with known or suspected coronary artery disease, but it is not directly related to the rsR' pattern in V2 5, 6.